• Title/Summary/Keyword: On-board recovery

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Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study

  • Thomas B. Russell;Peter L. Labib;Paula Murphy;Fabio Ausania;Elizabeth Pando;Keith J. Roberts;Ambareen Kausar;Vasileios K. Mavroeidis;Gabriele Marangoni;Sarah C. Thomasset;Adam E. Frampton;Pavlos Lykoudis;Manuel Maglione;Nassir Alhaboob;Hassaan Bari;Andrew M. Smith;Duncan Spalding;Parthi Srinivasan;Brian R. Davidson;Ricky H. Bhogal;Daniel Croagh;Ismael Dominguez;Rohan Thakkar;Dhanny Gomez;Michael A. Silva;Pierfrancesco Lapolla;Andrea Mingoli;Alberto Porcu;Nehal S. Shah;Zaed Z. R. Hamady;Bilal Al-Sarrieh;Alejandro Serrablo;Somaiah Aroori
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.1
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    • pp.70-79
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    • 2024
  • Backgrounds/Aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.

Analysis on the Users′ Behaviors and Satisfaction on the Actual Conditions of Management in Chiri Mountain National Park (지리산국립공원의 이용자 행태분석과 관리실태에 대한 만족도 조사에 관한 연구)

  • 김광래;진희성;김세천
    • Journal of the Korean Institute of Landscape Architecture
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    • v.16 no.2
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    • pp.43-57
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    • 1988
  • The purpose of this thesis is to suggest objective basic data for park management proposal through the quantitative analysis of users' behaviors and satisfaction for the actual conditions of management in the Chiri Mountain National Park. For this users' behaviors and socio-economic characteristics have been cross-analyzed. Specifically, it attempts to investigate users' anticipate and degree of satisfaction applied Expectancy Theory by Likert attitude scale. Users'behaviors patterns of each site have been analyzed by the factor analysis algorithm, and each factor scores of sites have been clustered by the cluster method. And also user' satisfaction for the actual conditions of management have been analyzed by using the multiple regression. The major user groups were students and youth groups accompanied by their friends ranging from 3 to 10. The values of user'post occupancy-evaluation for such as rockwall climbing and praying on the mountain of each site showed higher than those of anticipated, but evaluation values of other activities were lower. The user'behaviors of each site have been analyzed five factors by factor analysis algorithm. By using the control method for the number of factors, T.V. has been obtained as 50.58%. The factor score of factor covering the behavior patterns of student and youth yield high EV. and C.V.. On the analysis of cluster using factor score, factor IV in Hwaomsa temple site and Ssanggyesa temple site, factor II, v in Jungsanri Valley site, factor, I, III in Bangmudong valley site and factor I. IV in Baemsagol vallry site showed very high values, respectively. According to the multiple regression analysis, the major variables related to the satisfaction for the actual conditions of vegetation and landscape managements were reservation of groundcover, recovery of artificial injury, the surroundings of camping and temple site. In the park facilities and operation, the major variables related to the satisfaction were conditions of management such amenity facilities as privy, sign board, junk yard, camping site, and guidance of excursion, campaign and preservation of nature.

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The Limitation of Air Carriers' Cargo and Baggage Liability in International Aviation Law: With Reference to the U.S. Courts' Decisions (국제항공법상 화물.수하물에 대한 운송인의 책임상한제도 - 미국의 판례 분석을 중심으로 -)

  • Moon, Joon-Jo
    • The Korean Journal of Air & Space Law and Policy
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    • v.22 no.2
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    • pp.109-133
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    • 2007
  • The legal labyrinth through which we have just walked is one in which even a highly proficient lawyer could easily become lost. Warsaw Convention's original objective of uniformity of private international aviation liability law has been eroded as the world community ha attempted again to address perceived problems. Efforts to create simplicity and certainty of recovery actually may have created less of both. In any particular case, the issue of which international convention, intercarrier agreement or national law to apply will likely be inconsistent with other decisions. The law has evolved faster for some nations, and slower for others. Under the Warsaw Convention of 1929, strict liability is imposed on the air carrier for damage, loss, or destruction of cargo, luggage, or goods sustained either: (1) during carriage in air, which is comprised of the period during which cargo is 'in charge of the carrier (a) within an aerodrome, (b) on board the aircraft, or (c) in any place if the aircraft lands outside an aerodrome; or (2) as a result of delay. By 2007, 151 nations had ratified the original Warsaw Convention, 136 nations had ratified the Hague Protocol, 84 had ratified the Guadalajara Protocol, and 53 nations had ratified Montreal Protocol No.4, all of which have entered into force. In November 2003, the Montreal Convention of 1999 entered into force. Several airlines have embraced the Montreal Agreement or the IATA Intercarrier Agreements. Only seven nations had ratified the moribund Guatemala City Protocol. Meanwhile, the highly influential U.S. Second Circuit has rendered an opinion that no treaty on the subject was in force at all unless both affected nations had ratified the identical convention, leaving some cases to fall between the cracks into the arena of common law. Moreover, in the United States, a surface transportation movement prior or subsequent to the air movement may, depending upon the facts, be subject to Warsaw, or to common law. At present, International private air law regime can be described as a "situation of utter chaos" in which "even legal advisers and judges are confused." The net result of this barnacle-like layering of international and domestic rules, standards, agreements, and criteria in the elimination of legal simplicity and the substitution in its stead of complexity and commercial uncertainty, which manifestly can not inure to the efficient and economical flow of world trade. All this makes a strong case for universal ratification of the Montreal Convention, which will supersede the Warsaw Convention and its various reformulations. Now that the Montreal Convention has entered into force, the insurance community may press the airlines to embrace it, which in turn may encourage the world's governments to ratify it. Under the Montreal Convention, the common law defence is available to the carrier even when it was not the sole cause of the loss or damage, again making way for the application of comparative fault principle. Hopefully, the recent entry into force of the Montreal Convention of 1999 will re-establish the international legal uniformity the Warsaw Convention of 1929 sought to achieve, though far a transitional period at least, the courts of different nations will be applying different legal regimes.

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